Shoulder
Surgery
Your
shoulder is the most flexible joint in your body. It allows you to place and
rotate your arm in many positions in front, above, to the side, and behind your
body. This flexibility also makes your shoulder susceptible to instability and
injury.
Depending
on the nature of the problem, non surgical methods of treatment often are
recommended before surgery. However, in some instances, delaying the surgical
repair of a shoulder can increase the likelihood that the problem will be more
difficult to treat later.
Early, correct diagnosis and treatment of shoulder
problems can make a significant difference in the long run.
The shoulder is a ball-and-socket joint. It is made up of three bones: the upper arm bone (humerus), shoulder blade (scapula) and collarbone (clavicle).
The
ball at the top end of the arm bone fits into the small socket (glenoid) of the
shoulder blade to form the shoulder joint (glenohumeral joint).
The
socket of the glenoid is surrounded by a soft-tissue rim (labrum).
A
smooth, durable surface (articular cartilage) on the head of the arm bone, and
a thin inner lining (synovium) of the joint allows the smooth motion of the
shoulder joint.
The
upper part of the shoulder blade (acromion) projects over the shoulder joint.
One end of the collarbone is joined with the shoulder blade by the
acromioclavicular (AC) joint. The other end of the collarbone is joined with
the breastbone (sternum) by the sternoclavicular joint.
The
joint capsule is a thin sheet of fibers that surrounds the shoulder joint. The
capsule allows a wide range of motion, yet provides stability.
The
rotator cuff is a group of muscles and tendons that attach your upper arm to
your shoulder blade. The rotator cuff covers the shoulder joint and joint
capsule.
The
muscles attached to the rotator cuff enable you to lift your arm, reach
overhead, and take part in activities such as throwing or swimming.
A
sac-like membrane (bursa) between the rotator cuff and the shoulder blade
cushions and helps lubricate the motion between these two structures.
Shoulder
Problems and Treatments
Bursitis
or Tendinitis
Bursitis
or tendinitis can occur with overuse from repetitive activities, such as
swimming, painting, or weight lifting. These activities cause rubbing or
squeezing (impingement) of the rotator cuff under the acromion and in the
acromioclavicular joint. Initially, these problems are treated by modifying the
activity which causes the symptoms of pain and with a rehabilitation program
for the shoulder.
Impingement
and Partial Rotator Cuff Tears
Partial thickness rotator cuff tears can be associated with chronic inflammation and the development of spurs on the underside of the acromion or the acromioclavicular joint.
The
conservative nonsurgical treatment is modification of activity, light exercise,
and, occasionally, a cortisone injection. Nonsurgical treatment is successful
in a majority of cases. If it is not successful, surgery often is needed to
remove the spurs on the underside of the acromion and to repair the rotator
cuff.
Full-Thickness
Rotator Cuff Tears
Full-thickness rotator cuff tears are most often the result of impingement, partial thickness rotator cuff tears, heavy lifting, or falls. Nonsurgical treatment with modification of activity is successful in a majority of cases.
If
pain continues, surgery may be needed to repair full- thickness rotator cuff
tears. Arthroscopic techniques allow shaving of spurs, evaluation of the
rotator cuff, and repair of some tears.
Both
techniques require extensive rehabilitation to restore the function of the
shoulder.
Instability
Instability occurs when the head of the upper arm bone is forced out of the shoulder socket. This can happen as a result of sudden injury or from overuse of the shoulder ligaments.
The
two basic forms of shoulder instability are subluxations and dislocations. A
subluxation is a partial or incomplete dislocation. If the shoulder is
partially out of the shoulder socket, it eventually may dislocate. Even a minor
injury may push the arm bone out of its socket. A dislocation is when the head
of the arm bone slips out of the shoulder socket. Some patients have chronic
instability. Shoulder dislocations may occur repeatedly.
Patients
with repeat dislocation usually require surgery. Open surgical repair may
require a short stay in the hospital. Arthroscopic surgical repair is often
done on an outpatient basis. Following either procedure, extensive
rehabilitation, often including physical therapy, is necessary for healing.
Fractured
Collarbone and Acromioclavicular Joint Separation
A fractured collarbone and acromioclavicular separation are common injuries of children and others who fall on the side of their shoulder when playing. Most of these injuries are treated non surgically with slings or splints. Severe displaced fractures or acromioclavicular joint separation may require surgical repair.
Fractured
Head of the Humerus (Arm Bone), or Proximal Humerus Fracture
A fractured head of the humerus is a common result of falls on an outstretched arm, particularly by older people with osteoporosis. If fragmented or displaced, it may require open surgical repair and possibly replacement with an artificial joint (prosthesis).
Osteoarthritis
and Rheumatoid Arthritis
Osteoarthritis and rheumatoid arthritis can destroy the shoulder joint and surrounding tissue. They can also cause degeneration and tearing of the capsule or the rotator cuff. Osteoarthritis occurs when the articular surface of the joint wears thin. Rheumatoid arthritis is associated with chronic inflammation of the synovium lining which can produce chemicals that eventually destroy the inner lining of the joint, including the articular surface.
Shoulder replacement.
Shoulder replacement is recommended for patients with painful shoulders and limited motion. The treatment options are either replacement of the head of the bone or replacement of the entire socket .
The orthopaedic evaluation of your shoulder consists of three components:
- A medical history to gather information about current complaints; duration of symptoms, pain and limitations; injuries; and past treatment with medications or surgery.
- A physical examination to assess swelling, tenderness, range of motion, strength or weakness, instability, and/or deformity of the shoulder.
- Diagnostic tests, such as X-rays taken with the shoulder in various positions. Magnetic resonance imaging (MRI) may be helpful in assessing soft tissues in the shoulder. Computed tomography (CT) scan may be used to evaluate the bony parts of the shoulder.
We will review the results of your evaluation with you and discuss the best treatment. If surgery is the best option , you will be explained the benefits vs potential risks and complications .
- No food or drink after midnight before surgery.
- Discuss with us what to do about medications taken in the morning.
- Pre-anaesthetic check up prior to the surgery .
You
may be given the option to have an arthroscopic procedure or an open surgical
procedure.
Arthroscopy
Arthroscopy allows us to insert a pencil-thin device with a small lens and lighting system into tiny incisions to look inside the joint. The images inside the joint are relayed to a TV monitor, allowing us to make a diagnosis. Other surgical instruments can be inserted to make repairs, based on what is with the arthroscope. Arthroscopy often can be done on an outpatient basis.
Open
Surgery
Open surgery may be necessary and, in some cases, may be associated with better results than arthroscopy. Open surgery often can be done through small incisions of just a few inches.
Recovery
and rehabilitation is related to the type of surgery performed inside the
shoulder, rather than whether there was an arthroscopic or open surgical
procedure.
Possible
Complications After Surgery
There
are always some risks with any surgery, even arthroscopic procedures. These
include possible infection, and damage to surrounding nerves and blood vessels.
However, modern surgical techniques and close monitoring have significantly
minimized the occurrence of these problems.
After
surgery, some pain, tenderness, and stiffness are normal. You should be alert
for certain signs and symptoms that may suggest the development of
complications.
- Fever after the second day following surgery
- Increasing pain or swelling
- Redness, warmth, or tenderness which may suggest a wound infection
- Unusual bleeding (some surgical wound drainage is normal and, in fact, desirable
- Numbness or tingling of the arm or hand
Prevention of Future Problems & Summary
As
you can see, the shoulder is extremely complex, with a design that provides
maximum mobility and range of motion. Besides big lifting jobs, the shoulder
joint is also responsible for getting the hand in the right position for any
function. When you realize all the different ways and positions we use our
hands every day, it is easy to understand how hard daily life can be when the
shoulder isn't working well.
It
is important that you continue a shoulder exercise program with daily
stretching and strengthening. In general, patients who faithfully comply with
the therapies and exercises prescribed by the physical therapist will have the
best medical outcome after surgery.